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Outcomes of assisted reproductive technology after radical abdominal trachelectomy for early-stage cervical cancer
Shintaro Kamijo1, Risa Matsuda1, Mitsutoshi Yamada1
1Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
Objective:
To investigate clinical characteristics and in vitro fertilization (IVF) outcomes in patients after radical abdominal trachelectomy (RAT) for early-stage cervical cancer.
Design:
A retrospective cohort study of patients who underwent IVF after RAT between January 2009 and December 2022, with comparison to age-matched controls.
Subjects:
Forty-one patients who underwent RAT for early-stage cervical cancer and subsequently sought IVF, compared with 82 age-matched controls.
Exposure:
Radical abdominal trachelectomy as a fertility-sparing surgery for early-stage cervical cancer, followed by IVF.
Main Outcome Measures:
Embryological outcomes, clinical pregnancy rates, live birth rates, and factors influencing IVF success, including age at first oocyte retrieval, ovarian response parameters, number of oocytes retrieved, presence of cervical stenosis, and endometrial thickness at embryo transfer (ET) were compared between the RAT and control groups.
Results:
The RAT group had similar anti-mullerian hormone levels and embryological outcomes compared with controls. In the RAT group, clinical pregnancy and live birth rates were 68.3% (28/41) and 58.5% (24/41) per patient and 20.8% (37/178) and 15.7% (28/178) per ET, respectively. These rates were comparable to those in the control group, which were 62.2% (51/82) and 50.0% (41/82) per patient and 25.4% (80/314) and 16.6% (52/314) per ET, respectively. In the RAT group, live birth outcomes were associated with younger age at first oocyte retrieval, higher number of oocytes retrieved, fewer cases of cervical stenosis, and greater endometrial thickness at ET. An endometrial thickness of 9.2 mm was identified as the optimal statistical boundary for predicting both clinical pregnancy and live birth.
Conclusion:
The live birth rate in the RAT group was comparable to that in the age-matched control group, indicating that RAT does not negatively impact assisted reproductive technologies outcomes. Age at first oocyte retrieval, number of oocytes retrieved, presence of cervical stenosis, and endometrial thickness at ET may influence IVF outcomes after RAT.
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